Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal

Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature.Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems.Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%).Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect

Stressors Among Psychiatric Out-patients with Suicide Attempt Attending Tertiary Care Hospital in Eastern Nepal

Life changes could act as a stressor causing physiological arousal and enhance susceptibility for suicidal behavior. Suicide victims have experienced more changes in living conditions, work problems and object losses than normal controls. Objective of this study was to assess common stressors and stress level among psychiatric out-patients with suicide attempt. It was a descriptive study conducted with purposive sampling in a tertiary care hospital among suicide attempt cases visiting out-patient department of psychiatry. Calculated sample size of 113 cases were enrolled within 1 year period. Stressor factor (stressors, its type-acute or ongoing etc.) was explored and documented in a semi-structured Proforma in all subjects. Stress level was measured with Perceived Stress Scale (PSS). Demographic variables were recorded in a semi-structured proforma. Majority of the subjects were female, married and literate, with the commonest age group of 20- 29 and <20 years. Most subjects were homemakers, urban dwellers, Hindu and, were from low socioeconomic status and joint family. Among the patients; 86 (76.1%) had chronic on-going stressor, 23 (20.4%) acute stressor within 1 month and 4 (3.5%) did not reveal any stressor. Common stressor revealed were: economic (22.12%), marital (21.23%), relationship issue (20.35%), physical and mental illness (17.69%), substance use (13.27%), parental issue (6.19%), physical violence (6.19%), and loss or death of close ones (5.30%). Perceived Stress Scale showed 39% with high, 36% moderate and 21% low stress level within past 1 month. Management of suicide cases, hence, integrally involves stress management

An Experimental Impact Analysis of Bhagavad Gita in Mental State of Cancer Patients

Morbidity with cancer is stressful and cancer patients frequently present with depression, anxiety and stress related disorders. Psychotherapy is reported to decrease emotional distress, improve immunity and to reduce the chemotherapy doses. The Gita, a Hindu epic depicts one of the earliest documented sessions of Cognitive behavior therapy. Objectives of this study were: a. to assess the stress and ‘psychiatric caseness', b. to explore the effect of the Gita based psychotherapy on the mental state (GHQ) and c. to assess the effect of Bhajan/ Kirtan (religious music therapy) on the mental state (GHQ) among cancer patients. It was a cancer-hospital-based study using convenient and purposive sampling among cancer patients (study period- six months). We had three subject groups: Medicine as usual, Medicine plus Bhajan/Kirtan and Medicine plus Gita based therapy. With informed written consent, they were enrolled to apply the instruments: Perceived Stress Scale (Sheldon Cohen) to assess stress and General Health Questionnaire (GHQ-12) (David Goldberg) to assess ‘psychiatric caseness'. Majority of cancer patients (90%) had severe level of stress. Pre-intervention GHQ-12 Scores indicated that cancer patients with moderately depressed mood were 50% in medicine, 47% in Bhajan and 56% in Gita group. There was improvement in mental state as relief from depressed mood in 1 week of intervention in: 1% in Medicine, 14% in Bhajan and 41% in Gita group. The Gita based psychological intervention significantly improved depressed mood in Cancer patients